Officials struggle to get first flu shots to highest-risk patients

Thursday, October 13, 2005

WASHINGTON -- Delayed vaccine shipments to some health departments and doctors' offices are hindering efforts to protect the highest-risk patients -- even as grocery stores open mass flu-shot clinics.

Federal health officials insist there will be plenty of vaccine to go around in a few more weeks.

A manufacturer barred from the U.S. market last year, Chiron Corp., is to resume sales soon, a move that should boost the nation's ultimate supply to 91 million doses, said Dr. Ray Strikas of the Centers for Disease Control and Prevention.

But until Oct. 24, flu shots were supposed to be reserved for the elderly, babies, people with asthma and others at highest risk. After that, the shots are open to anyone. The CDC is getting complaints that many high-risk patients won't be reached by then, leaving them to compete for shots.

"Our phone has been ringing for the last two weeks from citizens: 'When can I come get my flu shot?'" said a frustrated Carol Moehrle of Idaho's North-Central District Health Department, which has postponed vaccinations at nursing homes because of delayed shipments.

"It puts us in an awkward situation with our public when they're looking to us to be a leader in this arena," said Moehrle, who has received only 20 percent of doses ordered, with no guarantee when the rest will arrive.

A survey of 120 local health departments around the country last week found all but six reporting delays in getting any vaccine or only partial shipments, said Patrick Libbey of the National Association of County & City Health Officials.

The sickest-first policy "is just not working out as had been planned," he said.

Meanwhile, mass purchasers are opening flu-shot clinics at pharmacies, grocery stores and other retailers -- places where doctors don't want their most frail patients to have to stand in line.

Elderly patients are "surprised and frustrated and annoyed that they have to search it out and can't get it at their doctor's office," said Dr. Ruth Kevess-Cohen, a geriatrician in Silver Spring, Md.

Her office ordered 1,400 flu shots in February from two distributors that won't say when, or even if, the first shipment will arrive; efforts to get doses elsewhere have failed. And shipments too late in the season may be wasted, as patients seek shots elsewhere or give up.

"We never used to have this problem," Kevess-Cohen said. CDC should "perhaps require that doctors' offices have as high a priority as grocery stores to get the vaccine."

CDC is tracking the complaints, and soon will begin assessing how to improve vaccination of the neediest next year, said CDC's Strikas.

There aren't simple solutions: Flu shots take months to brew, and must be made fresh each winter to match newly circulating influenza strains. The government is hunting for ways to speed the process and increase the number of vaccine manufacturers.

Some companies that run flu-shot clinics for grocery stores and other retailers say they comply with CDC's neediest-first policy. Maxim Health Systems, for example, provides a form telling customers to explain why they're at high risk.

Still, the complaints illustrate the shakiness of the vaccine system despite efforts at improvement after last year's debacle, when the nation's flu-shot supply was abruptly cut in half because of contaminated Chiron doses.

This year, there won't be shortages, Strikas stressed. Even without Chiron, there would be 71 million doses, most provided by Sanofi-Pasteur; about 8 million from GlaxoSmithKline, newly approved to sell flu shots in this country; and about 3 million doses of the nasal-spray vaccine FluMist, for healthy 5- to 49-year-olds.

But the Food and Drug Administration has begun clearing Chiron doses for sale, and the company told CDC Tuesday that it hoped to begin shipments in two weeks, Strikas said.

All Sanofi customers were supposed to received a partial shipment by last week to tide them over until full supplies make it through the pipeline, said Strikas, unable to explain to why some private distributors apparently hadn't yet done so.

Flu season doesn't usually peak until January, he noted.

"We have a lot of time yet to get vaccine into the arms or noses of people who want to get it," Strikas said.


On the Net:

American Lung Association flu-shot locator: http://www.flucliniclocator.org/

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